Provider Demographics
NPI:1265730717
Name:REAL LIFE COUNSELING, INC
Entity type:Organization
Organization Name:REAL LIFE COUNSELING, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:E
Authorized Official - Last Name:GAST
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMHC
Authorized Official - Phone:850-271-8258
Mailing Address - Street 1:221 E 23RD ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-7612
Mailing Address - Country:US
Mailing Address - Phone:850-271-8258
Mailing Address - Fax:
Practice Address - Street 1:221 E 23RD ST
Practice Address - Street 2:SUITE F
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-7612
Practice Address - Country:US
Practice Address - Phone:850-271-8258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MH7039
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7039251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZO26DOtherBCBS
FLMH7039OtherFL LICENSE
1164745352OtherNPI